PNO Delegation Oversight Coordinator

Summary

Under the direction of the Provider Network Operations (PNO) Delegation Oversight Supervisor, the Delegation Oversight Coordinator supports daily audit and monitoring processes to ensure high-quality reviews and results. They assist with coordinating large department projects or lead special projects, ensuring timely and successful completion. The Coordinator must deliver quality results under tight deadlines and maintain accurate records and documentation.

Duties and Responsibilities:

• Request, collect, and distribute documentation necessary for auditing and monitoring functions.
• Ensure all audit and monitoring documentation is complete and submitted on time.
• Maintain and update training materials and provider documentation for audit readiness.
• Assist in generating and distributing provider warning and non-compliance letters.
• Review and validate letter templates to ensure compliance with Health Plan, State, and Federal regulations.
• Prepare and submit standard and non-standard compliance documents, including detailed audit findings and reports.
• Conduct process reviews to ensure accuracy and validity of analytical results.
• Assist in revising audit tools and procedures in accordance with regulatory standards.
• Manage corrective action plans and track reporting needs.
• Maintain status logs for assigned projects and contribute to delegation oversight activity reports.
• Ensure strict adherence to HIPAA compliance and follow organizational policies and procedures.
• Perform additional duties and assignments as needed.

Minimum Job Requirements:

• Bachelor’s Degree (preferred)
• 2+ years of experience in Managed Care or Healthcare, particularly in Provider Network Management (a plus)
• Knowledge of Health Plan Provider Network oversight and audit processes (a plus)
• EZ-CAP knowledge and experience (a plus)
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Skills and Abilities:

• Strong verbal and written communication skills
• Excellent attention to detail and organizational abilities
• Ability to prioritize and manage multiple tasks and projects simultaneously
• Strong interpersonal skills with the ability to collaborate effectively
• Critical thinking and problem-solving abilities

Salary Range:

• $25 to $30 per hour